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Opportunities and Challenges - Nicotine Dependence · PDF fileOpportunities and Challenges ......

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  • PREGNETSPhone: (416) 535-8501 ext. 6662 Fax: (416) 595-6821Email: [email protected]

    Smoking Cessation in Pregnancy: Opportunities and Challenges

    Compliments of: Program Training and Consultation Centre, Ontario Tobacco Strategy. References available upon request

  • SMOKING CESSATION IN PREGNANCY

    Opportunities and Challenges

    I. Why is pregnancy a good time to intervene?

    II. How can I be most helpful?

    III. What tools are available to help me and my patients/clients?

  • I. Why is pregnancy agood time to intervene?

    II. How can I be most helpful?

    III. What tools are available to help me and my patients/clients?

  • 1a) Maternal smoking in pregnancy has risks to mother and baby.

    n more problems in pregnancyn placenta previa, abruptio placenta, ectopic pregnancy,

    premature rupture of membranes

    n higher risk of miscarriagen more problems in labour and deliveryn higher risk of losing the baby before birth, during

    birth or shortly after birthn low birthweight, prematurity, small for gestational age

    n higher risk of Sudden Infant Death Syndrome (crib death)

    n breathing problems n weaker baby

  • 1b) Maternal smoking affects the baby after birth.

    n crankier babyn baby spits up moren more ear infectionsn more colds, coughs, bronchitis, pneumonian lower lung functionn more hospital daysn more likely to be hyperactiven may be behind others in reading and math skillsn more likely to be victim of a house firen more likely to get sick or die from eating cigarette

    butts (4 butts can kill a baby)

  • 1c) Motivation

  • Building motivation

    1. Address misperceptions smokers may have.

  • Building motivation

    1. Address misperceptions smokers may have.2. Address the postpartum period in the prenatal

    intervention.

  • Building motivation

    1. Address misperceptions smokers may have.2. Address the postpartum period in the prenatal

    intervention.3. Build in partner support.

  • Building motivation

    1. Address misperceptions smokers may have.2. Address the postpartum period in the prenatal

    intervention.3. Build in partner support.4. Encourage smoking reduction as an alternative

    to smoking cessation for those unable to quit.

  • How Many Smokers Quitin Pregnancy?

    n 80% try to quit or reduce smoking

    n 23% maintain cessation over the course of their pregnancy

    n An additional 17% cut down by more than 5 cigarettes per day.

    Source: Edwards et al, 1994Source: Edwards et al, 1994

  • Who is Most Likely to Quit?

    n higher educatedn lighter smokersn those who live with nonsmokersn those with stronger beliefs in the harms

    of smokingn those experiencing their first pregnancy

    Source: Stewart et al, 1994Source: Stewart et al, 1994

  • Why Do Some Women Return to Smoking Postpartum?n The babys healthy, I can smoke again.

    n It will help me cope with the stress of my new responsibilities.

    n It will help me lose the weight I gained.

    n Its the only way I can get a time out

  • How Many Women Return to Smoking Postpartum?

    n Among women who quit smoking during pregnancy, over 60% start smoking again by 6 months postpartum.

    n Women are most vulnerable to relapse in the first 6-12 weeks postpartum.

  • I. Why is pregnancy agood time to intervene?

    II. How can I be most helpful?

    III. What tools are available to help me and my patients/clients?

  • RNAO Recommendations(draft)Integrating Smoking Cessation Intervention into Daily Nursing Practice

    n Every nurse will offer brief counselling and minimal intervention (1-3 minutes)

    n Some nurses will offer more intensive smoking cessation interventions (client wants to quit, nurse has the knowledge and time)

    n Nurses implement, wherever possible, intensive intervention with women who are pregnant or post-partum

    n Nurses encourage smokers and nonsmokers to make their homes smoke-free.

  • Canadian Smoking Cessation Guidelines, 2000, p2.

    Smoking is a chronic addiction.You can make a difference.

    There are quick, effective interventions to treat your patients tobacco addiction.

    in a nutshell...

  • n Smokers make an average of 3-4 quit attempts over 7-10 years before they achieve long-term maintenance (Smoking cessation guidelines, p6)

    n Implications: n Repeated intervention is often requiredn You wont experience success with everyone

    smoking is a chronic addiction

  • you can make a difference

    Physician, Dental Team, Nurse, Pharmacist, Other Health Care 12% Professional

    Non-medical professional 14% (psychologist, social worker, counselor)

    Multiple Providers 26%

    Source: US AHCPR Clinical Practice Guidelines, 1996

    MEDIAN QUIT RATE (1 year)

  • there are quick, effective interventionsEfficacy improves with treatment intensity, BUT, lower

    contact interventions are effective because:

    n They workn Smokers prefer themn Reduces barriers associated with other interventions

    n time, cost, flexibility, child care, transportation, ease of use, embarrassment from failure

    n More efficient than other methods

  • Impact of Smoking Cessation Interventions

    Intervention Efficacy Reach Popn #quitters

    Self help 5% 30% 1,000 15Brief counselling 10% 50% 1,000 50Group program 20% 5% 1,000 10

  • Two Easy Steps

    s Assess stage of change.

    s Tailor intervention to stage of change.

  • I. Why is pregnancy agood time to intervene?

    II. How can I be most helpful?

    III. What tools are available to help me and my patients/clients?

  • for you for your clients

    n Asking to Listen

    n Videon Book

    n Quitting When You are Ready for you and your baby

    n One Step at a Timen How Not to Smoken Toronto Programs

    Guiden Individual tools (see

    Appendix 3 Asking to Listen)

  • Pharmacological Supports for Smoking Cessation in Pregnancy

    First encourage pregnant smokers to quit without pharmacological aid (green book p13)

    Pharmacotherapy should be considered when a pregnant smoker is otherwise unable to quit, and when the likelihood of quittingand its potential benefits outweigh the risks of the pharmacotherapy and continued smoking (blue book p92)*

    Use the lowest possible effective dose (of NRT) (green book p13)There are no adequate studies of bupropions use or safety in

    pregnancy (green book p13)

    * Be aware that NRT manufacturers and the CPS state that any form of nicotine administration is contraindicated in pregnant and breastfeeding women.

  • Elements of the Self-Help Booklet1.Building Commitment:

    During the pregnancy encourages woman to:Know why she has chosen to quit Think about reasons for staying quit

    For the postpartum it encourages the woman to:Remember what she has achievedReview her short- and long-term commitments Try not to be influenced by others expectation

  • 2. Making A Plan:Focuses on: Understanding the process of quitting (stages of behaviour

    change) Understanding herself (understanding what smoking means to

    her) Documenting what she learns about herself and smoking Finding support from significant other Expecting the unexpected Expecting change Reviewing and revising her plan to reflect changes

  • 3.Managing The Environment:

    While pregnant: Make no-smoking rules for her home Handling the challenge of partner smoking Removing reminders Avoiding smoke

    Postpartum Explain to others that the same no-smoking rules apply as

    in pregnancy.

  • 4.Coping With Cravings:

    Suggests: Be aware of whats happening Be prepared to resist it Remember that it will not last long Use a non-smoking alternative whenever feel the need to

    smoke.

  • 5.Healthy Avoidance:

    While pregnant: Learn what she enjoyed most about smoking Identify past smoking routines Document past smoking routines Change past routines. Avoid coffee, alcohol

    Postpartum Avoid giving in Dont blame quitting for added stress Avoid coffee, alcohol

  • 6.Dealing With Difficult Situations -Slips

    Encourages:

    Normalcy of slips Know what to expect Learn why she slipped Maintain motivation and stay up Maintain self-confidence Strengthen commitment Get back on track

  • ASK

    Non-smoker

    Smoker or

    Ex-Smoker(< 6mo)

    Ex-smoker(>6 mo)

    ADVISE"As your health care provider, I strongly

    advise you to quit (stay quit)"

    ASSIST

    Minimalreferral to community resource

    self-help materialSmoker's Helpline 1-877-513-5333

    IntensivePros and Cons of Quitting

    Meaning of Smoking Quit date

    Nicotine DependencePharmacotherapy options

    Encourage & Support

    ARRANGEfollow-upor refer to

    smoking cessation program

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